Roll of bills pours out pills.
Roll of bills pours out pills. - 
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Jeremy Hobson: We are one year into the the Obama health care law. And most of the law's major provisions haven't kicked in yet. But hospitals and insurance companies are ramping up preparation efforts. One provision involves insurance cooperatives, or co-ops, which are meant to be a low-cost insurance option.

Marketplace's Nancy Marshall Genzer visited a clinic in Maryland that's trying to morph into a co-op.

Nancy Marshall Genzer: The clinic is in Howard County, Md., just outside Baltimore. Posters on the wall urge preventive dental care for babies and tell pregnant women with AIDS to get counseling. The clinic is part of a county program for the uninsured and working poor called Healthy Howard. Patients pay $50 to $85 a month for a set number of doctor visits.

Deborah Dunn: All right, have a seat here, let me check you out.

Deborah Dunn is a physician's assistant with Healthy Howard. She's seen a lot of people who lost their jobs, and insurance, during the financial crisis.

Dunn: I'm seeing patients having heart attacks and strokes as a result of not being able to afford their medications because of losing their insurances.

These are the types of people the co-op would serve. Healthy Howard and the co-op are the brainchild of the county health officer, Dr. Peter Beilenson. He's using Healthy Howard as a blueprint for his co-op, taking it statewide. Beilenson's co-op would charge a low monthly premium. Patients would see staff doctors who earn a straight salary, instead of being paid by the procedure. Each patient would be given a personal "health coach" and "action plan" to kick bad habits. Sounds hokey, but Beilenson says it's paid off at Healthy Howard.

Peter Beilenson: Poor eating habits, lack of exercise, smoking. So we work on all of those things and that's helped reduce costs.

And that's the idea behind the co-ops: inject some nimble competition into a health insurance market dominated by giants. Sabrina Corlette is a health policy analyst at Georgetown University.

Sabrina Corlette: You have, in many states, one or two big insurers dominating 70, 80, even 90 percent of the market. So the whole idea behind the co-op plans was to use that competition to bring prices down for consumers.

Beilenson says the co-op would charge about $300 a month for a family of four. Maryland will be setting up an exchange where people can shop for health insurance as part of the health care law. Beilenson expects the co-op to be listed when the exchange opens in 2014.

In Washington, I'm Nancy Marshall Genzer for Marketplace.